Method for humerus retraction

ABSTRACT

A method for performing surgery on a shoulder joint utilizes one positionable support arm attached to a retractor support apparatus. The method includes incising a patient to expose the shoulder joint. After exposing the shoulder joint, the humeral ball is dislocated from the glenoid cavity. A retractor is mounted to one of the support arms at a proximal end. A humerus retractor blade at a distal end of the humerus retractor engages the humerus. The humerus retractor blade is positioned about the humerus and a mechanical system within the humerus retractor is manipulated to laterally displace the humeral ball from the glenoid cavity.

CROSS-REFERENCE TO RELATED APPLICATION(S)

[0001] The present application is a continuation-in-part of U.S.application Ser. No. 09/654,400 and claims priority therefrom.

BACKGROUND OF THE INVENTION

[0002] The present invention relates to a method of surgical retraction.In particular, the present invention relates to a method of retractingthe humerus during shoulder surgery.

[0003] Total shoulder replacement (arthroplasty) operations have beenperformed for many decades to repair shoulder components. Thesecomponents include the glenoid cavity (socket portion of the shoulder)and the humeral head (ball portion of the shoulder). The shoulder istypically replaced due to a gradual deterioration or wearing of theglenoid cavity and/or the humeral head or ball. Common causes of thedeterioration of the shoulder joint from smooth surfaces where the jointis properly articulating to rough surfaces where articulation of thejoint is painful include osteoarthritis, Rheumatoid arthritis as well astrauma which injures the shoulder joint. The deterioration causes eitherthe humeral ball, the glenoid cavity or both the humeral ball and theglenoid cavity become rough which results in pain when the shoulderjoint is articulated.

[0004] Surgical procedures have been the most successful method toalleviate this type of shoulder pain. Either partial or total shoulderreplacement surgery can be performed. In a total shoulder replacementprocedure, a cup shaped insert, typically manufactured of polyethylene,is inserted into the worn glenoid cavity and a metal ball is used toreplace the humeral head. A partial shoulder replacement is performedwhen either the humeral ball is replaced or the glenoid cavity isrepaired with an insert.

[0005] The shoulder replacement surgery is conducted by making anincision through the skin into the front of the shoulder. Typically, theincision is about three inches long. Because of the relatively smallsize of the incision and the surgical site being on one side of thebody, access to the surgical site is limited.

[0006] After making the incision through the skin, the surgeon dividesthe tissue and muscle to expose the shoulder joint. When the humeralball is replaced, the surgeon separates the humeral bone from thehumerus, typically with a bone saw. The surgeon has two options whenseparating the humeral ball from the humerus. The humeral ball may beseparated from the humerus while the humeral ball remains within theglenoid cavity. Alternatively, the humeral ball may be dislocated fromthe glenoid cavity followed by the humeral ball being separated from thehumerus.

[0007] After separating the humeral ball from the humerus, the arm isretracted away from the body, or laterally. The arm is usually retractedwith a hand-held retractor where the surgeon or an assistant must applya constant force upon the humerus. One hand-held retractor that is usedfor retracting the humerus is called a Fakuda blade. A Fakuda blade hasa flat surface with a curved end. An aperture is disposed within theFakuda blade which better grips the humerus than a blade having only aflat surface.

[0008] After laterally retracting the humerus, the humeral ball isdislocated from the glenoid cavity, thereby exposing the glenoid cavityfor insertion of the cup shaped insert. Additionally, laterallyretracting the humerus away from the shoulder joint makes the freshlycut portion of the humerus accessible for replacement of the humeralball.

[0009] The humerus is prepared by hollowing a cavity into the interiorof the humerus with a rasp to create a place for the humeral ballcomponent to be attached to the humerus. The metal humeral ball includesa stem which is inserted into the hollowed out cavity in the humerus.The metal humeral ball is fixedly attached to the humerus by techniqueswhich are known in the art including, but not limited to, cement or anon-cement technique, such as bony ingrowth.

[0010] Typically, at least two strong people are needed to perform atotal shoulder replacement. One person is needed to retract the humerusfrom the glenoid cavity to gain access to both the glenoid cavity andthe humerus. The other person is needed to prepare the glenoid cavityand the humerus for the insert and metal ball, respectively. After thereplacement components are inserted, the shoulder is reducted (thehumeral component is inserted into the glenoid cavity component) tocheck the angle and fit of the humeral ball into the glenoid cavityinsert. If the shoulder components do not adequately fit, the shoulderis again dislocated, the components readjusted, and the humeral ball ispositioned in the glenoid cavity. If the stability and placement of thetrial inserts is acceptable, the shoulder is dislocated and the humeralimplant stem is placed into and secured within the hollowed cavity ofthe humerus. The humeral ball is again positioned within the glenoidcavity and the stability of the arthroplasty is confirmed.

[0011] Due to the multiple dislocations and insertions of the humeralball into the glenoid cavity, as well as retracting the humerus, thesurgical procedure can become quite physically taxing on the surgeon orsurgeons performing it. The surgical procedure requires lifting andmoving the patient's arm into multiple positions. At times, the surgeonmay need to hold the arm in a selected position for an extended periodof time. Depending on the size of the patient, the strenuous activitycan lead to fatigue and contribute to surgical error. Additionally, therepeated movement of the arm can cause nerve damage if it is not doneprecisely and with minimal adjustment. When the surgeon moves thehumerus by hand it is common to have continual adjusting occur. Often,the surgeon holding the arm, relaxes or becomes fatigued and allows thearm to move, requiring that the arm be readjusted. The movement cancause the arm to pinch or rub nerves or muscle tissue, possibly causingdamage.

BRIEF SUMMARY OF THE INVENTION

[0012] The present invention includes a method for performing surgery ona shoulder joint using at least one positionable support arm attached toa retractor support apparatus, where the shoulder joint includes aglenoid cavity, a humerus and a humeral ball attached to the humerus andpositioned within the glenoid cavity. The method includes incising apatient to expose the shoulder joint. After exposing the shoulder joint,the humeral ball is dislocated from the glenoid cavity. A retractor ismounted to one of the support arms at a proximal end. A humerusretractor blade at a distal end of the retractor engages the humerus.The humerus retractor blade is positioned about the humerus and amechanical system within the humerus retractor is manipulated tolaterally displace the humeral ball from the glenoid cavity.

BRIEF DESCRIPTION OF THE DRAWINGS

[0013]FIG. 1 is a perspective view of a support structure for a shouldersurgery.

[0014]FIG. 2 is a perspective view of a retractor mechanism having anarticulated joint for adjusting a height of a retractor blade.

[0015]FIG. 3 is a perspective view of a retractor mechanism having amechanical system for adjusting a longitudinal position of a retractorblade.

[0016]FIG. 4 is a perspective view of the support members for a shoulderoperation.

[0017]FIG. 5 is a partial perspective view of a humerus beinglongitudinally retracted from the glenoid cavity with a retractor bladehaving an aperture therein.

[0018]FIG. 6 is an exploded view of the retractor mechanism of thepresent invention.

[0019]FIG. 7 is a partial perspective view of a mechanism for attachinga retractor blade to the retractor mechanism.

DETAILED DESCRIPTION

[0020] The present invention relates to a method for retracting theupper arm or humerus bone during a shoulder surgery as generallyillustrated in FIG. 1 at 10. In preparation for a shoulder replacementsurgery, a height of a generally J-shaped member 16 is adjusted byclamping the support member 14 in a selected position on a retractorsupport apparatus 12 with a clamp 13.

[0021] To provide adequate support around the shoulder while maintainingaccess to the shoulder to be operated upon, the generally J-shapedmember 16 is attached to the support member 14 as illustrated in FIG. 1.The generally J-shaped member 16 includes an arcuate portion 18proximate a first end 19, a substantially straight middle portion 20 andan outwardly extending portion 22 proximate a second end 21. An engagingportion 24 which engages the support member 14 is positionedsubstantially perpendicular to the outwardly extending portion 22. Theengaging portion 24 is designed to engage the docking member disclosedin U.S. application Ser. No. 09/654,400 from which this application is acontinuation-in-part and which is hereby incorporated by reference inits entirety.

[0022] Referring to FIGS. 1 and 4, the generally J-shaped member 16includes substantially uniformly spaced apart apertures 26 along thearcuate portion 18 proximate a first end 19 and also the substantiallystraight middle portion 20. A T-shaped member 28 having a plurality ofapertures 30 along the long portion 32 of the T-shaped member 28 isoperably attached to the generally J-shaped member 16. The T-shapedmember 28 includes first and second pegs 36, 38 proximate first andsecond ends 40, 42, respectively, of a short portion 34, as illustratedin FIG. 4. The first and second pegs 36, 38 engage the uniformly spacedapart apertures 26 in the generally J-shaped member 16 such that theT-shaped member 28 is positionable along the generally J-shaped member16.

[0023] Referring to FIGS. 1 and 5, the surgical procedure begins byadjusting the height of the support structure 14. The generally J-shapedmember 16 is rotatably positioned about a shoulder 40 to be surgicallyrepaired. The first and second pegs 36, 38 of the T-shaped member 28 arepositioned in a selected position within the plurality of apertures 26in the generally J-shaped member 16. The combination of the generallyJ-shaped member 16 and the T-shaped member 28 provide the requiredsupport structure for performing the operation while maintaining accessto the surgical site. The selected location of the T-shaped member 28 isdetermined by the type of surgical procedure to be performed, the sizeof the incision to be made and the size of the patient being operatedupon.

[0024] Referring to FIG. 5, an incision 13 is made into the flesh of thepatient. Retractors 44, 46, as best illustrated in FIG. 2, are securedto both the generally J-shaped member 16 and the T-shaped member 28 andretract the flesh from the incision 13 thereby exposing the shoulderjoint 40. With the shoulder joint 40 exposed, the glenoid cavity 41, thehumeral ball 43 and an upper portion of the humerus 45 are viewablethrough the retracted incision 13.

[0025] Referring to FIGS. 1, 5 and 6, a retractor mechanism 50 issecurely positioned on the generally J-shaped member 16 by a cooperationof a pin 52 extending downwardly from a bottom surface 54 of a gearboxassembly 56 with one of the apertures 26 within the generally J-shapedmember 16. The pin 52 is in a perpendicular relationship with the bottomsurface 54 and extends through a thickness of the generally J-shapedmember 16. Preferably, the thickness of the generally J-shaped member 16is ¼″ and the pin 52 is ¾″ in length. An end of the pin 52 extendsapproximately ½ inch below the bottom surface of the generally J-shapedmember 16. The excess length of the pin 52 prevents the retractormechanism 50 from rotating off of the generally J-shaped member 16 whena force is applied to a retractor blade 44, 46 or 200. The only methodof removing the retractor mechanism 50 from the generally J-shapedmember 16 is to lift the gearbox assembly 56 away from atop surface ofthe generally J-shaped member 16 until the pin 52 disengages theaperture 26 within the generally J-shaped member 16. While the pin 52 isdisposed within the aperture 26, the retractor mechanism 50 is pivotallyattached to the generally J-shaped member 16.

[0026] The gearbox assembly 56 includes a gearbox casing 58 attached toan outer casing 60. The outer casing 60 is preferably U-shaped andincludes the bottom surface 54 to which the pin 52 is attached, a topsurface 62 and a first side surface 64. The gearbox casing 58 includesfirst and second shoulders 66, 68 which contact a first end 59 and asecond end 61 of the outer casing 60. The shoulders 66, 68 are designedsuch that each shoulder is even with the top and bottom surfaces 62, 54,when the gearbox casing 58 engages the outer casing 60.

[0027] The gearbox casing 58 extends within the outer casing 60 suchthat a first surface 70 of the gearbox casing 58 and the top surface 62,the bottom surface 54 and the first side wall 64 define a retractorhandle bore 66. The retractor handle bore 66 is preferably substantiallyrectangular in configuration, although other cross-sectionalconfigurations are within the scope of the invention. The retractorhandle bore 66 is positioned proximate a second side 67 of the gearboxassembly 56.

[0028] A channel 71 is disposed along a length of the first surface 70of the gearbox casing 58. A pawl retaining cavity 72 is machined intothe channel 71 proximate a second end 80 of the gearbox assembly 56. Thepawl retaining cavity 72 extends to an outer surface of the gearboxcasing 58.

[0029] A gear bore 74 is positioned proximate a first side 76 and afirst end 78 of the gearbox assembly 56. The gear bore 74 is in asubstantially orthogonal relationship with the retractor handle bore 66.The gear bore 74 is in communication with the retractor handle bore 66.

[0030] A pawl 82 is inserted into the pawl retaining cavity 72 andretained within the cavity 72 by a cooperation of a pin 84 beinginserted into an aperture 86 within the top surface 62, a bore (notshown) which extends into the pawl retaining cavity 72 and a bore 81through the pawl 82 which is aligned with the bore (not shown) in thegearbox casing 58. Additionally, a bore (not shown) may continue throughthe pawl retaining cavity 72 to secure an end of the pin 84 within anon-moving part. The pin 84 has an engaging portion 86 proximate a head88 which creates a frictional engagement of the pin 84 with the bore(not shown) within the gearbox casing 58, thereby retaining the pin 84within the gearbox assembly 56 and the pawl 82 within the pawl retainingcavity 72.

[0031] A retractor handle 90 is disposed through the retractor handlebore 66. The retractor handle 90 is preferably a three sided channel 93which cooperates with the rectangular retractor handle bore 66.Extending from a first side 92 of the retractor handle is a rack (notshown) of a rack and pinion system (not shown). When the retractorhandle 90 is disposed within the retractor handle bore 66, the rack (notshown) extends within the channel 71 of the retractor handle bore 66.

[0032] A gear pin 94 is inserted into the gear bore 74 from the topsurface of the outer casing 60. A gear 96, having pinions 98 disposedannularly around a circumference of the gear pin 94, is disposed withinthe gear bore 74 such that the pinions 98 extend into the channel 71 andengage grooves which define the rack (not shown). The gear pin 94 has abore (not shown) extending from an end which is aligned about a centralaxis of the gear pin 94. A retaining pin 100 is inserted through anaperture (not shown) within the bottom surface of the outer casing 60aligned with the bore (not shown) within the gear pin 94 when the gearpin 94 is within the gear bore 74. The retaining pin 100 includes anengaging portion 99 with a slightly larger diameter than the pin whichsecures the pin 100 within the bore (not shown) of the gear pin 94thereby securing the gear pin 94 within the gear bore 74.

[0033] A length of the rack (not shown) determines the maximum distancethat the retractor handle 90 can be moved through the retractor bore 66by the manipulation of the rack and pinion system (not shown). Thesurgeon is easily able to manipulate the position of a retractor blade21 by rotating the gear pin 94 which in turn rotates the pinions 98 ofthe gear 96. The interaction of the rotating pinions 98 with the rack(not shown) causes the retractor handle 90 to move longitudinally withrespect to the retractor handle bore 66 thereby allowing the surgeon tomove the retractor blade 21 laterally into a desired position as bestillustrated in FIG. 3.

[0034] Referring back to FIG. 6, the pawl 82, which is pivotallyattached to the gearbox casing 58 by the pin 84, includes a notch 102proximate a first end 101. The notch 102 includes a substantially rightcorner which engages the pinions 98 of the gear 96 such that the gear 96cannot be rotated in a reverse direction without first displacing thenotch 102 from the pinions 98 of the gear 96. The pawl 82 is biased toengage the notch 102 with the pinions by a compression spring 104engaging a shoulder 106. The spring 104 biases a second end 103 towardan outer edge of the gearbox casing 58 such that the second end 103extends past the edge of the gear box casing 58. While the second end103 of the pawl 82 is biased toward the edge, the first end 101 isbiased toward the pinions 98. The pawl 102 prevents accidental movementof the retractor handle 90 when the rack and pinion system (not shown)applies a force to the humerus 45 and laterally retracts the humeralball 43 from the glenoid cavity 41. A length of a surface 108 proximatethe second end 103 of the pawl 82 prevents the second end 103 fromengaging the grooves defining the rack (not shown).

[0035] Referring to FIG. 2, an articulated joint 110 allows theretractor blade 200 to be raised or lowered relative to a blade end 91of the retractor handle 90 by a pivot pin 112. Referring back to FIG. 6,the retractor handle 90 has a rectangular channel 93 disposed through alength of the retractor handle extending from the blade end 91 to ahandle end 89.

[0036] A push rod 114 extends through the length of the channel 93within the retractor handle 91. A first end 113 of the push rod 114 isdisposed through an aperture at the handle end 89 of the retractorhandle 90. A first shoulder 116 proximate the first end 113 contacts theaperture, thereby fixing the push rod 114 in a selected position withrespect to the retractor handle 90 while maintaining rotatability of thepush rod 114. A washer 118 is disposed over the first end 113 of thepush rod 114 and a knob 116 is fixedly attached to the first end 113 ofthe push rod 114. The washer 118 prevents the handle end 89 of theretractor handle 90 from goring a surface of the knob 116 and bindingthe knob 116 to the handle end 89 of the retractor handle 90.

[0037] Intermediate the first end 113 and a second end 115 of the pushrod 114 is a center portion 120 defining a second shoulder 122 and athird shoulder 124. The center portion 120 has a larger diameter thanthe diameter of portions adjacent to the center portion 120. Thedifferences in the diameters define the second and third shoulders 122,124. A spacer 126 is disposed over the second end 115 of the push rod114. The second end 115 of the push rod 114 is threaded and threadablyengages a threaded bore (not shown) within a first end 130 of a firstwedge 128.

[0038] The first wedge 128 has a substantially rectangular cross-sectionproximate the first end 130. The rectangular cross-sectional portion ofthe first wedge 128 cooperates with the rectangular channel 93 withinthe retractor handle 90 which prevents the first wedge 128 from rotatingwithin the rectangular channel 93. Because the first wedge 128 does notrotate when the push rod 114 is rotated, the threadable engagement ofthe push rod 114 with the bore (not shown) within the first wedge 128causes the first wedge 128 to move relative to the second end 115 of thepush rod 114 when the push rod 114 is rotated. A first wedge surface 134is defined by a flat surface extending from a top surface 136 to an edgeat the bottom surface 138 at a second end 132.

[0039] A mounting member 140 includes a bore 142 which aligns with firstand second apertures 95, 97 within the first side and a second sides ofthe retractor handle 90. A pivot pin 144 is inserted through the firstaperture 95, the through bore 142 and the second aperture 97 therebypivotally attaching the mounting member 140 to the retractor handle 90.

[0040] Proximate a first end 141 of the mounting member 140 is a secondwedge surface 146. The second wedge surface 146 extends from a topsurface 148 intermediate the first end 141 and a second end 143 to abottom surface 150 proximate the first end 141. An angled surface152extends upwardly at a slant from the bottom surface 150 toward the firstend 141 such that the first end 141 of the mounting member 140 isdefined by an edge above the bottom surface 150.

[0041] As the push rod 114 is rotated, the second end 132 of the firstwedge surface 134 engages the angled surface 152 of the mounting member140. Further movement of the first wedge surface 134 toward the mountingmember 140 causes the mounting member 140 to pivot about the pivot pin144 while the angled surface 152 travels up the first wedge surface 134.The second wedge surface 146 has a circular recess 154 which cooperateswith a compression spring 156. An end of the compression spring 156rests on a substantially flat, bottom surface of the circular recess154. Another end of the compression spring 156 is positioned against aninner surface of a top portion 85 of the retractor handle 90.

[0042] As the angled surface 152 travels up the first wedge surface 134,the compression spring 156 compresses which biases the angled surface152 to travel down the first wedge surface 134 as the first wedge 128 ismanipulated away from the mounting member 140. One skilled in the artwill realize that the second wedge surface 146 allows for greaterpivotal movement of the mounting member 140 because the first end 141 ofthe mounting member 140 will not contact the top portion 85 of theretractor handle 90 until the second wedge surface 146 contacts the topportion 85. One skilled in the art will also recognize that because themounting member 140 is pivotally attached to the retractor handle 90between the first end 141 and a second end 143 that as the first end 141is raised the second end 143 is lowered and vice versa.

[0043] Referring to FIG. 7, a cylindrical portion 160 extends from themounting member 140. A through bore 161 is disposed through thecylindrical portion 160 proximate the second end 143 of the mountingmember 140. A shoulder 164 is defined proximate an end of thecylindrical portion 160.

[0044] A plug 166 having a bore 168 extending from a first end 170 to asecond end 171 is disposed over the cylindrical portion 160 of themounting member 140 until the first end 170 is adjacent to the shoulder164. With the first end 170 of the plug adjacent to the shoulder 164, afirst slot 172 within a first side surface 176 of a rectangular body 175and a second slot 174 within a second side surface 178 of therectangular body 175 are aligned with the through bore 161 within thecylindrical portion 160.

[0045] A pin 180 is inserted through the first slot 172, the throughbore 161 and the second slot 174. An end of the pin 180 is substantiallyeven with an outer surface of the first side surface 176 and another endof the pin 180 is substantially even with an outer surface of the secondside surface 178. Neither end of the pin 180 extends past the outersurfaces of the first and second side surfaces 176, 178. The slots 172,174 are wider than the diameter of the pin 180 allowing the plug 166 topartially rotate about the cylindrical portion 160 until the pin 180contacts either surface of the slots 172, 174. Preferably, the plug 166rotates 10 to 20 degrees about the cylindrical portion 160.

[0046] A retractor engaging member 182 having a rectangular bore (notshown) extending from a first end 183 cooperates with the rectangularbody 175 of the plug 166. The cooperation of the rectangular body 175with the rectangular bore (not shown) prevents rotation of the retractorengaging member 182 about the plug 166. The retractor engaging member182is slidably positioned on the plug 166 until the first end181 of theretractor engaging member 182 contacts a shoulder 177 about the plug166. The outer surface around a perimeter of the shoulder 177 is evenwith the rectangular outer surface of the retractor engaging member 182.

[0047] Proximate a second end 185 of the retractor engaging member 182is the through bore 162. Extending from an end 201 of a retractor blade200 is a cylindrical member 202 which cooperates with the through bore162. The cooperation of the cylindrical member 202 with the through bore186 allows the retractor blade 200 to rotate about the cylindricalmember 202 while being retained therein.

[0048] Referring to FIG. 5, the present invention includes the humerusretractor blade 200 attachable to the retractor mechanism 50 by thecooperation of the cylindrical member 202 attached to the blade 200 withthe through bore 162 in the retractor blade engaging member 182. Thehumerus retractor blade 200 resembles a Fakuda blade having a generallyflat portion 204 with an arcuate end portion 206 and an aperture 208disposed within the generally flat portion 204 and extending into thearcuate end portion 206. The aperture 208 in the humerus retractor blade200 is used to better grip bone and flesh at the surgical site.

[0049] Prior to making an incision, the generally J-shaped member 16 andthe T-shaped member 28 are adjusted to desired positions by the surgeon.After an incision 13 has been made, the flesh is retracted to expose theshoulder joint 40 by standard retractor blades 44, 46 which are wellknown in the art. After exposing the shoulder joint 40, the retractingmechanism 50, to which the humerus retractor blade 200 is attached, ispositioned in a desired location by inserting the pin 52 extending fromthe bottom surface 54 of the gearbox assembly 56 into an aperture 26within the generally J-shaped member 16.

[0050] After positioning the retracting mechanism 50 in the desiredaperture 26, the gear pin 94 is manipulated to position the humerusretractor blade 200 medially beyond the humerus 45 proximate the humeralhead 43 by rotating the gear pin 94. The rotation of the gear pin 94causes the pinions 98 of the gear 96 to engage the rack (not shown)attached to the retractor handle 90 which causes the retractor handle 90and the humerus retractor blade 200 to move toward the humerus 45. Oncethe humerus retractor blade 200 is positioned on a medial side (bodyside) of the humerus 45 proximate the humeral ball 43, the height of theretractor blade 200 is adjusted.

[0051] The height of the humerus retractor blade 200 is adjusted bymanipulating the articulated joint 110 by rotating the knob 116proximate the handle end 89 of the retractor handle 90 as illustrated inFIG. 2. Rotating the knob 116 causes the first wedge 128 to engage theangled surface 152 of the mounting member 140 causing the first end 141of the mounting member 140 to rise up the first wedge 128. As the firstend 141 rises up the first wedge 128, the second end 143 of the mountingmember 140 pivots downward about the pin 144. The second end 143 ispivoted downward until the arcuate end 206 of the humerus retractorblade 200 is positioned about the humerus 45 on a medial side of thehumerus 45. The position of the humerus retractor blade 200 can beslightly adjusted by rotating the retractor engaging member 182 aboutthe cylindrical portion 160 of the mounting member 140.

[0052] With the arcuate end portion 206 of the humerus retractor blade200 in the desired location, the gear pin 94 is rotated in an oppositedirection thereby causing the mechanical system, preferably but notlimited to a rack and pinion system (not shown), to move the retractorhandle 90 and the humerus retractor blade 200 laterally, as illustratedin FIG. 3, away from the shoulder joint 40. The humerus retractor blade200 is used to retract the humerus 45 after separation from the humeralball 43 or after the humeral ball 43 is dislocated from the glenoidcavity 41 but prior to being separated from the humerus 45. As theretractor blade 200 is moved away from the shoulder joint 40 by the rackand pinion system (not shown), a lateral force is applied to the humerus45 until the humerus 45 is displaced a desired distance from the glenoidcavity 41. With the humeral ball 43 displaced from the glenoid cavity41, the humeral ball 43 is replaced and an insert is disposed within theglenoid cavity 41 to repair the glenoid cavity 41.

[0053] The pawl 82 engages the pinions 98 of the gear 96, preventing theretractor handle 90 from inadvertently moving toward the shoulder joint40 and releasing the force applied by the humerus retractor blade 200.Additionally, the pawl 82 allows the surgeon to rest if needed duringthe surgical procedure without having to reapply the force alreadyexerted upon the humerus 45.

[0054] The use of the mechanically adjustable retractor mechanism 50allows the humerus 45 to be displaced from the glenoid cavity 41 using aminimum amount of force and a minimum amount of movement as necessary toperform the shoulder replacement surgery. Using only the required forceand minimizing movement reduces the amount of trauma to the patient andreduces the amount of time required to recover.

[0055] Additionally, the use of the humerus retractor blade 200 alongwith the retractor mechanism 50 to laterally retract the humerus 45 fromthe glenoid cavity 41 reduces the number of surgeons required to performthe surgical procedure. The reduction in personnel required to performthe surgery is possible because a surgeon is not needed to provide aforce to displace the humerus 45 laterally from the glenoid cavity 41.Rather, the rack and pinion system (not shown) is used in the place ofadditional surgical personnel which provides the surgeon with betteraccess to the limited surgical site.

[0056] Once the necessary procedures have been performed on the glenoidcavity 41 and the humerus 45, the pawl 82 is disengaged from the gearpinions 98 and the rotation of the gear pin 94 is reversed to manipulatethe rack and pinion system (not shown) which, in turn, positions thehumeral ball 43 proximate the glenoid cavity 41. With the humeral ball43 proximate the glenoid cavity 41, the humerus retractor blade 200 isdisengaged from the humerus 45. Once the humerus retractor blade 200disengages the humerus 45, the surgeon raises the pin 52 from theaperture 26 thereby removing the retractor mechanism 50 from thesurgical site. With the implanted humeral ball 43 adjacent to therepaired glenoid cavity 41, the surgeon forces the humoral ball 43 intothe surgically repaired glenoid cavity 41.

[0057] Although the present invention has been described with referenceto preferred embodiments, workers skilled in the art will recognize thatchanges may be made in form and detail without departing from the spiritand scope of the invention.

1. A surgical apparatus mounted to a surgical table, wherein theapparatus engages and manipulates a position of a bone within a surgicalsite, the apparatus comprising: a support member operably attached tothe surgical table, the support member positioned proximate the surgicalsite; and a retractor operably attached to the support member, theretractor comprising: a handle having a proximal end and a distal end;and a blade having a proximal end and a distal end wherein the proximalend of the blade attaches to the distal end of the handle, the bladecomprising a substantially flat central portion and an inwardly arcuateportion proximate the distal end.
 2. The apparatus of claim 1 whereinthe blade of the retractor further comprises a surface defining anaperture disposed within the substantially flat central portion.
 3. Theapparatus of claim 2 wherein the blade of the retractor furthercomprises the surface defining the aperture being further disposedwithin the inwardly arcuate portion proximate the distal end.
 4. Theapparatus of claim 1 wherein the handle of the retractor furthercomprises a mechanical mechanism wherein the mechanical mechanismadjusts a lateral position of the blade.
 5. The apparatus of claim 4wherein the mechanical mechanism of the handle further comprises: acasing operably attached to the support member, the casing comprising athrough bore and a gear bore in communication with the through bore; ashaft disposed through the through bore and having a rack disposed alonga length of the shaft; and a gear disposed within the gear bore, thegear having a plurality of pinions wherein the pinions engage the rackof the shaft to adjust the lateral position of the blade.
 6. Theapparatus of claim 5 wherein the shaft of the handle of the retractorfurther comprises a through bore along the length of the handle.
 7. Theapparatus of the claim 6 wherein the handle further comprises: a pushrod disposed through the through bore in the shaft, the push rod havinga first end and a second end, the second end being threaded; and a firstblock having a first end and a second end, the first end threadablyattached to the threaded second end of the shaft and a first rampedsurface proximate a second end of the first block.
 8. The apparatus ofclaim 7 wherein the handle further comprises a second block pivotallyattached to a distal end of the shaft, the second block having aproximal end and a distal end, the distal end of the second block beingattached to the blade and wherein the first end comprises a secondramped surface wherein the first ramped surface of the first blockengages the second ramped surface of the second block to adust avertical position of the blade.
 9. A table mounted surgical retractorfor retracting a bone within a surgical site, the table having a supportarm operably attached thereto, the retractor comprising: a handleoperably attached to the support arm, the handle comprising a proximalend and a distal end; and a blade having a proximal end and a distal endwherein the proximal end of the blade attaches to the distal end of thehandle, the blade comprising a substantially flat central portion and aninwardly arcuate portion proximate the distal end.
 10. The retractor ofclaim 9 wherein the blade of the retractor further comprises a surfacedefining an aperture disposed within the substantially flat centralportion.
 11. The retractor of claim 10 wherein the blade of theretractor further comprises the surface defining the aperture beingfurther disposed within the inwardly arcuate portion proximate thedistal end.
 12. The retractor of claim 9 wherein the handle of theretractor further comprises a mechanical mechanism wherein themechanical mechanism adjusts a lateral position of the blade.
 13. Theretractor of claim 12 wherein the mechanical mechanism of the handlefurther comprises: a casing operably attached to the support member, thecasing comprising a through bore and a gear bore in communication withthe through bore; a shaft disposed through the through bore, the shaftcomprising a rack disposed along a length of the shaft; and a geardisposed within the gear bore, the gear having a plurality of pinionswherein the pinions engage the rack of the shaft to adjust the lateralposition of the blade.
 14. The retractor of claim 13 wherein the shaftof the handle of the retractor further comprises a through bore alongthe length of the handle.
 15. The retractor of the claim 14 wherein thehandle further comprises: a push rod disposed through the through borein the shaft, the push rod having a first end and a second end, thesecond end being threaded; and a first block having a first end and asecond end, the first end threadably attached to the threaded second endof the shaft and a first ramped surface proximate the second end of thefirst block.
 16. The retractor of claim 15 wherein the handle furthercomprises a second block pivotally attached to a distal end of theshaft, the second block having a proximal end and a distal end, thedistal end of the second block being attached to the blade and whereinthe second block at the proximal end comprises a second ramped surfacewherein the first ramped surface of the first block engages the secondramped surface of the second block to adust a vertical position of theblade.
 17. A table mounted surgical retractor for retracting a bonewithin a surgical site, the table having a support arm operably attachedthereto, the retractor comprising: a handle operably attached to thesupport arm, the handle comprising a proximate end and a distal end; anda blade having a proximal end and a distal end wherein the proximal endof the blade attaches to the distal end of the handle, the bladecomprising a substantially flat central portion and an inwardly arcuateportion proximate the distal end and wherein the blade further comprisesa surface defining an aperture disposed within the substantially flatcentral portion and extending into the inwardly arcuate portionproximate the distal end.
 18. The retractor of claim 17 wherein thehandle of the retractor further comprises a mechanical mechanism whereinthe mechanical mechanism adjusts a lateral position of the retractorblade.
 19. The retractor of claim 18 wherein the mechanical mechanism ofthe handle further comprises: a casing operably attached to the supportmember, the casing comprising a through bore and a gear bore incommunication with the through bore; a shaft disposed through thethrough bore and having a rack disposed along a length of the shaft; anda gear disposed into the gear bore, the gear having a plurality ofpinions wherein the pinions engage the rack of the shaft to adjust thelateral position of the blade.
 20. The retractor of claim 19 wherein theshaft of the handle of the retractor further comprises a through borealong the length of the handle.
 21. The retractor of the claim 20wherein the handle further comprises: a push rod disposed through thethrough bore in the shaft, the push rod having a first end and a secondend, the second end being threaded; and a first block having a first endand a second end, the first end threadably attached to the threadedsecond end of the shaft and a first ramped surface proximate the secondend of the first block.
 22. The retractor of claim 21 wherein the handlefurther comprises a second block pivotally attached to a distal end ofthe shaft, the second block having a proximal end and a distal end, thedistal end of the second block being attached to the blade and whereinthe second block at the proximal end includes a second ramped surfacewherein the first ramped surface of the first block engages the secondramped surface of the second block to adust a vertical position of theblade.